Effects of Comprehensive Outpatient Cardiac Rehabilitation on Exercise Capacity, Functional Status, and Quality of Life in People With Heart Failure: A Systematic Review and Meta-Analysis.
Effects of Comprehensive Outpatient Cardiac Rehabilitation on Exercise Capacity, Functional Status, and Quality of Life in People With Heart Failure: A Systematic Review and Meta-Analysis.
复制标题
综合门诊心脏康复对心力衰竭患者运动能力、功能状态和生活质量的影响：系统评价和荟萃分析。
DOI：
10.1093/ptj/pzad119
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发表时间：
2023
期刊：
影响因子：
3.2
通讯作者：
Kumar,Amit
中科院分区：
文献类型：
--
作者：
Gore,Shweta;Khanna,Hargun;Kumar,Amit
目的本研究的目的是系统回顾并进行荟萃分析，探讨综合门诊心脏康复对心力衰竭患者运动能力、功能状态和生活质量的影响。方法使用心力衰竭和心脏康复的关键词和MeSH术语检索PubMed、Embase和CINAHL。其中包括以英文发表的针对心力衰竭患者进行基于门诊运动的心脏康复的随机临床试验。建议评估、制定和评估的分级用于质量评估。使用标准化平均差 (SMD) 和 95% CI 计算汇总估计值。主要结果是功能状态（6 分钟步行距离、生活质量、使用峰值耗氧量的运动能力、肌肉力量和耐力）。结果分析了 11 项随机对照试验，包括 1523 名年龄从 45 岁到 80 岁的参与者，干预持续时间从 2 到 26 周不等。汇总结果表明，综合心脏康复在 6 分钟步行距离（SMD = 0.30；95% CI= 0.06 至 0.54）和耗氧量（SMD = 0.23；95% CI= 0.06 至 0.40）方面有显着改善。然而，除了对照组之外，没有对生活质量产生额外的好处。结论这项研究的结果表明，与心脏康复环境中的单成分运动计划、非心脏康复环境中的多成分运动或不运动相比，综合门诊心脏康复与显着更好的临床结果相关。影响心力衰竭与运动耐量差的风险增加显着相关。尽管个别随机临床试验证明心脏康复对运动耐量和身体活动有好处，但关于其对运动能力、功能状态和生活质量等临床结果的影响的问题仍然不足。这项系统评价和荟萃分析为支持综合门诊心脏康复以改善心力衰竭的临床结果提供了强有力的证据。
PurposeThe purpose of this study was to systematically review and conduct a meta-analysis to examine the impact of comprehensive outpatient cardiac rehabilitation on exercise capacity, functional status, and quality of life in patients with heart failure.MethodsPubMed, Embase, and CINAHL were searched using keywords and MeSH terms on heart failure and cardiac rehabilitation. Randomized clinical trials published in English using outpatient exercise-based cardiac rehabilitation in patients with heart failure were included. The Grading of Recommendations Assessment, Development, and Evaluation was utilized for quality appraisal. Pooled estimates were computed using standardized mean differences (SMDs) and 95% CIs. Primary outcomes were functional status (6-minute walk distance, quality of life, exercise capacity using peak oxygen consumption, muscle strength, and endurance).ResultsEleven randomized controlled trials including 1523 participants ranging from 45 to 80 years old and an intervention duration ranging from 2 to 26 weeks were analyzed. Pooled results indicated significant improvements with comprehensive cardiac rehabilitation on 6-minute walk distance (SMD = 0.30; 95% CI = 0.06 to 0.54) and oxygen consumption (SMD = 0.23; 95% CI = 0.06 to 0.40). However, there was no additional benefit for the quality of life beyond that seen in the comparison groups.ConclusionResults of this study suggest that comprehensive outpatient cardiac rehabilitation is associated with significantly better clinical outcomes than single-component exercise programs in cardiac rehabilitation settings, multicomponent exercise in noncardiac rehabilitation settings, or no exercise.ImpactHeart failure is significantly associated with an increased risk of poor exercise tolerance. Despite the proven benefit of cardiac rehabilitation on exercise tolerance and physical activities from individual randomized clinical trials, questions regarding its impact on clinical outcomes such as exercise capacity, functional status, and quality of life remain inadequate. This systematic review and meta-analysis provides strong evidence supporting comprehensive outpatient cardiac rehabilitation for improving clinical outcomes in heart failure.